<!DOCTYPE html>
<html>
	<head>
		<meta charset="UTF-8">
		<title></title>
		  <#assign base=request.contextPath  />
		 <link rel="stylesheet" href="${base}/js/layui/css/layui.css?t=1534970980648" media="all">
		 <script type="text/javascript" src="${base}/js/zhang.js"></script>
		 <script src="${base}/js/layui/layui.js" charset="utf-8"></script>
         <script type="text/javascript" src="${base}/js/ztree/jquery-1.4.4.min.js"></script>
         <script src="${base}/js/jquery.min.js"></script>

		<style type="text/css">
		form{
		  padding:20px;
		}
		.layui-btn-radius{
        			border-radius: 5px;
        		}
		</style>
	</head>
	<body>

	<form class="layui-form" action="">
            <div class="layui-form-item">

                     <div class="layui-inline">
                              <label class="layui-form-label"><a style="color:red">*</a>&nbsp;房间号</label>
                                    <div class="layui-input-block">
                                           <select name="city" lay-verify="required" lay-search="" class=" isNull" id="home_id">
                                            	<option value=""></option>

                                            </select>
                                       </div>
                                   </div><br/><br/>

                <div class="layui-inline">
                     <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;姓名</label>
                           <div class="layui-input-inline">
                                <input name="number" id="name" lay-verify="required" autocomplete="off" class="layui-input isNull" type="text">
                            </div>
                          </div>








                           <div class="layui-inline">
                                      <label class="layui-form-label"><a style="color:red">*</a>&nbsp;出生年月</label>
                                           <div class="layui-input-inline">
                                                   <input name="date" id="date1" lay-verify="date" placeholder="yyyy-MM-dd" autocomplete="off" class="layui-input isNull" type="text">
                                             </div>
                                       </div>



                              <div class="layui-inline">
                                      <label class="layui-form-label"><a style="color:red">*</a>&nbsp;大概预产期</label>
                                               <div class="layui-input-inline">
                                                          <input name="date" id="date2" lay-verify="date" placeholder="yyyy-MM-dd" autocomplete="off" class="layui-input isNull" type="text">
                                                 </div>
                                      </div>




                            <div class="layui-inline">
                                  <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;家庭地址</label>
                                      <div class="layui-input-inline">
                                           <input name="number" id="address" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                      </div>
                            </div>





                             <div class="layui-inline">
                                           <label class="layui-form-label"><a style="color:red">*</a>&nbsp;成交日期</label>
                                               <div class="layui-input-inline">
                                                     <input name="date" id="date" lay-verify="date" placeholder="yyyy-MM-dd" autocomplete="off" class="layui-input isNull" type="text">
                                                </div>
                                          </div>

                            <div class="layui-inline">
                                  <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;电话</label>
                                      <div class="layui-input-inline">
                                           <input name="number" id="phone" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                      </div>
                            </div>


                            <div class="layui-inline">
                                        <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;微信</label>
                                               <div class="layui-input-inline">
                                                          <input name="number" id="weixin" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                               </div>
                                    </div>


                             <div class="layui-inline">
                                    <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;沟通时长</label>
                                             <div class="layui-input-inline">
                                                        <input name="number" id="howLong" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                                 </div>
                                          </div>
                          <div class="layui-inline">
                                <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;客户来源</label>
                                            <div class="layui-input-inline">
                                                  <input name="number" id="customerSource" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                          </div>
                                </div>



                           <div class="layui-inline">
                               <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;是否接送</label>
                                          <div class="layui-input-inline">
                                           <input name="number" id="Relay" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                        </div>
                               </div>


                                <div class="layui-inline">
                               <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;有无产前陪同</label>
                                          <div class="layui-input-inline">
                                           <input name="number" id="PrenatalEscort" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                        </div>
                               </div>


                        <div class="layui-inline">
                              <label class="layui-form-label"><a style="color:red">*</a>&nbsp;套餐项</label>
                                    <div class="layui-input-block">
                                           <select name="city" lay-verify="required" class=" isNull" id="setMeal">
                                            	<option value=""></option>

                                            </select>
                                       </div>
                                   </div><br/><br/>


                                        <div class="layui-inline">
                               <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;病历史</label>
                                          <div class="layui-input-inline">
                                           <input name="number" id="disease" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                        </div>
                               </div>
                            <div class="layui-inline">
                                      <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;计划生产医院</label>
                                               <div class="layui-input-inline">
                                                    <input name="number" id="hospital" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                              </div>
                                      </div>
                            <div class="layui-inline">
                                    <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;押金</label>
                                             <div class="layui-input-inline">
                                                    <input name="number" id="deposit" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                               </div>
                                        </div>
                             <div class="layui-inline">
                                        <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;定金</label>
                                                 <div class="layui-input-inline">
                                                      <input name="number" id="setMoney" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                                      </div>
                                               </div>
                               <div class="layui-inline">
                                            <label class="layui-form-label" ><a style="color:red">*</a>&nbsp;有无特殊需求</label>
                                                      <div class="layui-input-inline">
                                                               <input name="number" id="specialRequirements" lay-verify="required"  autocomplete="off" class="layui-input isNull" type="text">
                                                    </div>
                                             </div>










                   <div class="layui-form-item">
                           <div class="layui-input-block">
                               <button class="layui-btn layui-btn-radius" lay-submit lay-filter="formDemo" type="button" onclick="onSubmit()" style="background-color: #0092EF;">立即提交</button>
                               <button type="reset" class="layui-btn layui-btn-primary layui-btn-radius">重置</button>
                         </div>
                   </div>
                </div>
            </form>

<script>
layui.use(['form', 'layedit', 'laydate','layer'], function(){
  var form = layui.form
  ,layer = layui.layer
  ,layedit = layui.layedit
  ,laydate = layui.laydate;
   //日期
  laydate.render({
    elem: '#date'
  });

});



</script>
	</body>
</html>
